Responding to Increased Wildfire Smoke in British Columbia: What pharmacists and pharmacy technicians need to know

Updated on July 16, 2021 (Originally posted on August 21, 2019) The Tablet

BC Government photo

By Dorothy Li  B.Sc.(Pharm), CSPI, BC Drug and Poison Information Centre
Reviewed by Sarah Henderson, PhD Senior Scientist, Environmental Health Services, BC Centre for Disease Control

Although wildfires are a normal and natural part of summers in British Columbia, the 2017 and 2018 seasons were two of the most devastating on record. Approximately 65,000 people were evacuated in 2017 and more than 1.2 million hectares burned in both summers, releasing at least 200 million tonnes of smoke into the atmosphere each year.

Hot and dry conditions, thunderstorms, and damage caused by the mountain pine beetle all played a role. Climate change scientists forecast worsening wildfires and smoke across North America over the coming decades. Exposure to wildfire smoke has been associated with a wide range of health outcomes, from increased respiratory symptoms through to premature mortality. The following discusses these health effects in more detail, the public health response in B.C., and opportunities for pharmacists and pharmacy technicians to make a positive contribution.

Health effects of wildfire smoke

The composition of wildfire smoke is complex, depending on vegetation type, moisture content, weather and combustion temperature. Wildfires can generate a huge amount of air pollution with plumes that travel hundreds or thousands of kilometers. The most health-relevant components include: particulate matter less than 2.5 micrometers in diameter (PM2.5), volatile organic compounds (VOC), carbon monoxide, other gases and trace heavy metals.  Of these, PM2.5 concentrations are considered the best indicator of wildfire smoke health risks. The PM2.5 can deposit deep in the respiratory tract causing oxidative stress and inflammation that can affect other areas, particularly the cardiovascular system. Exposure to the larger particles, VOCs, and other gases can cause irritation to mucous membranes. The most common symptoms of wildfire smoke exposure are irritation, rhinitis, cough, phlegm, wheezing, and headaches. Most healthy people recover from these acute effects when the smoke clears, but some people may develop dyspnea, severe cough, dizziness, chest pain, or heart palpitations. 

Most research has been limited to epidemiological designs requiring large sample sizes. The frequency of certain health outcomes during periods of exposure is generally compared with periods of non-exposure. Health outcomes studied include mortality, hospital admissions, emergency room visits, primary health-care visits, and medication dispensations for specified diseases. These studies have most consistently linked wildfire smoke to asthma and chronic obstructive pulmonary disease (COPD) exacerbations, acute bronchitis, pneumonia, and otitis media. While strong evidence shows that PM2.5 from other sources (traffic, industry, domestic fuel) has cardiovascular effects including death, population-based studies on wildfire smoke have been inconsistent. These studies may have been limited by exposure misclassification or small study populations. Toxicological studies in animal models, however, do support the potential for cardiovascular effects. 

Certain populations are identified at higher risk: people with chronic conditions (asthma, COPD, heart disease, and diabetes), pregnant women and the developing fetus, infants and children, and the elderly. Children may be at particular risk because they spend more active time outdoors, inhale more air per body mass and have immature lungs. Elderly may have decreased lung function and pre-existing lung, heart, or other conditions that put them at increased risk. 

The mental health impacts of wildfire smoke are not well understood, but people exposed to wildfire events have increased rates of post-traumatic stress, depression and anxiety. Risk factors include evacuation, physical injury and property damage. During the Northwest Territories wildfires in 2017, prolonged time indoors and evacuation lead to isolation and feelings of fear, stress and uncertainty. Disruption of traditional activities for First Nations communities also affected livelihood and food security. Much more research on wildfire smoke is needed to elucidate these outcomes, as well as to assess the long-term risks, specific effects on the developing fetus, and the efficacy of recommended interventions. 

Responding to wildfires 

Following the severe wildfire season of 2010, B.C. introduced a provincial coordination group and guideline document to assist future response to smoke events. To provide guidance to the coordination group and the public, the BC Centre for Disease Control (BCCDC) systematically reviewed wildfire smoke health effects, populations at risk, tools for surveillance and interventions. The reviews concluded that staying indoors reduced asthma symptoms and use of portable air cleaners improved health outcomes, and the BCCDC therefore recommended these as intervention strategies. Other recommendations include: staying well hydrated, avoiding strenuous work or exercise outdoors, cancelling outdoor events, and spending time in cleaner air spaces, such as libraries and community centres. Key messages for the public are being distilled into a series of fact sheets available online.

The BCCDC also developed the B.C. Asthma Prediction System (BCAPS), which tracks PM2.5 concentrations and salbutamol dispensations to predict the health impacts of smoke exposures 24 to 48 hours before they occur. This validated tool assists medical health officers with making public health recommendations, such as contacting pharmacies to ensure adequate salbutamol supply, intimating the provision of clean air shelters, or making informed decisions about community evacuations in the worst case scenario.  


There are practical ways pharmacists and pharmacy technicians can respond to wildfire events (see Table 1).

Before wildfire season starts

Prompt patients with asthma or COPD to visit their physician for written action plans to recognize and respond to worsening symptoms; assist them in establishing an adequate supply of their rescue medications. Such action plans decrease emergency visits and hospital admissions. 

During wildfire season

Stay tuned to the Air Quality Health Index (AQHI), local air quality reports and advisories; maintain an adequate supply of bronchodilator and corticosteroid inhalers; recommend patients carry their bronchodilator (reliever) inhaler with them at all times. 

During times of poor air quality

Offer delivery services to at-risk populations; emphasize minimizing exposure to wildfire smoke while clarifying the role of N95 respirators. Limiting time spent outdoors offers more practical protection than wearing a N95 respirator for most people, especially those at higher risk. People who must work outdoors during smoky conditions may benefit from wearing a properly fitted and fit-tested N95 respirator. Refer these clients to WorkSafeBC. 

During evacuations and declared provincial states of emergency

Dispense an emergency supply of medications to displaced persons (prescription not required).

Wildfire smoke exposure is an increasingly important public health issue. Being informed and prepared for wildfire season can help pharmacists and pharmacy technicians care for people affected by wildfire smoke events.  


1. Wildfire Season Summary. [Pages on the Internet]. Government of BC. . Accessed June 22, 2019. .

2. Culbert, Lori. BC's worst wildfire seasons were in 2017 and 2018. What will happen in 2019? Vancouver Sun. Updated: April 6, 2019. . Available at: Accessed June 22, 2019.

3. Fire & Fuel Management. [Page on the Internet]. Government of British Columbia. Available at: Accessed June 26, 2019.

4. Impacts of 2017 Fires on Timber Supply in the Cariboo Region. Forest Analysisa nd inventory Branch, Office of the Chief Forester, BC Ministry of Forests, Lands, Natural Resource Operationsa nd Rural Development. February 2018. [Document on the Internet]. Available at: Accessed June 29, 2019. : s.n.

5. Impacts of 2018 Fires on Forests and Timber Supply in British Columbia. Forest Analysis and Inventory Branch Office of th Chief Fcorester, BC Ministry of Forests, Lands, Natural resource Operatonsa nd Rural Devlopment. April 2019. Available at: Accessed: June 29, 2019.

6. IPCC, 2014: Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, R.K. Pachauri and L.A. Meyer (eds.)]. IPCC, Geneva, . Switzerland, 151 pp.

7. Adetona O, Reinhardt TE, Domitrovich J, Broyles G, Adetona AM, Kleinman MT, et al. Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol. 20016;28(3):95-139. doi: 10.3109/08958378.2016.1145771.

8. Particulate Matter (PM) Basics. United States Environmental Protection Agency. [Page on the internet]. Available at: Accessed. June 30, 2019.

9. BC Health Wildfire Smoke response Coordination Guideline.Government of BC 2017.[Document on the Internet]. Accessed June 28, 2019.

10. Liu JC, Pereira G, Uhl SA, Bravo MA, Bell ML. A systematic review of physical health impacts from non-occupational expousre to wildfire smoke. Environ Res. 2015;120-132. doi:10.1016/j.envres.2014.10.015.

11. Reid CE, Brauer M, Johnston FH, Jerrett M, Balmes JR, Elliott CT. 2016. Critical review of health impacts of wildfire smoke exposure. Environ Health Perspect 124:1334–1343;

12. Guidance for BC Public Health Decision Makers During Wildfire Smoke Events. BC Centre for Disease Control. 2014. [Document on the internet]. Accessed July 1, 2019.

13. Naeher LP, Brauer M, Lipsett M, Zelikoff JT, Simpson CD, Koenig JQ et al. Woodsmoke health effects: A review. Inhalation Toxicology. 2017;19:67-106.

14. Black C, Tesfaigzi Y, Bassein JA, Miller LA. Wildfire smoke exposure and human health: significant gaps in reserach for a prowing public health issue. Environ Toxicol Pharmacol. 2017;55:186-195. doi:1016/j.etap.2017.08.002.

15. Yao J. Evidence Review: exposure measures for wildfire smoke surveillance. March 31, 2014. . Available at: Accessed: June 22, 2019.

16. Duran S. Evidence review: wildfire smoke and public heatlh risk. March 31, 2014. Available at: Accessed June 7, 2019.

17. Cascio WE. Wildland fire smoke and human health. Science Total Environment. 2018;624:586-595.

18. The Composition of Wildfire Smoke. BCCDC Wildfire Fact Sheet. [Document on the Internet]. Avaialble at: Accessed June 22, 2019.

19. Ammann H, Blaisdell R, Lipsett M, Stone SL, Therriault S. Wildfire Smoke. A Guide for Public Health Officials. EPA. [Document on the internet]. Available at: Accessed: July 2, 2019.

20. Health effects of wildfire smoke. BCCDC WildFire Fact Sheet. [Document on the internet]. Available at: Accessed: June 22, 2019.

21. Moore D, Copes R, Risk R, Joy R, Chan K, Brauer M. Population health effects of air quality changes due to forest fires in British Columbia in 2003. Can J Public Health. 2006;97(2):105-108. .

22. Henderson SB, Brauer M, MacNab YC, Kennedy SM. Three mesures of forest fires smoke exposure and their respiratory and cardiovascular health outcomes in a population-based cohort. Environ Heatlh Perspect. 2011;119:1266-1271.

23. Delfino RJ, Brummel S, Wu J, Stern H, Ostro B, Lipsett M, et al. The relationship of respiraotry and cardiovascular hospital admissions to the southern California wildfires of 2003. Occup Environ Med. 2009;66(3):189-197. doi: 10.1136/oem.2008.041376.

24. Yao J, Eyamie J, Henderson SB. Evaluation of a spatially resolved forest fire smoke model for population-based epidemiologic exposure assessment. J Exposure Science Environmental Epidemiology. 2016;26:233-240; doi.10.1038/jes.2014.67.

25. Elliott CT, Henderson SB, Wan V. Time series analysis of fine particulate matter and asthma reliever dispensations in populations affected by forest fires. Environmental Health. 2013;12(11):1-9.

26. Ali MU, Liu G, Yousaf B, Ullah H, Abbas Q, Munir MAM. A systematic review on global pollution status of particulate matter-associated potential toxic elements and health persepectives in urgan environment. Environ Geochem Heatlh. 2018. .

27. Yang Y, Ruan Z, Wang X, Yang Y, Mason TG, Lin H, et al. Short-term and long-term exposures to fine particulate matter constitutents and health: A systematic review and meta-anlysis. Environmental Pollution. 2019;874-882.

28. Morrison K. Evidence Review: Health surveillance for wildfire smoke events. March 31, 2014. [Document on the internet] . Available at: Accessed: June 22, 2019.

29. Finlay SE, Moffat A, Gazzard R, Baker D, Murray V. Health impacts of Wildfires. PLoS Curr. 2012; November 2; 4:e4f95995cce2c.

30. Agyapong VIO, Hrabok M, Juhas M, Omeje J, Denga E, Nwaka B, et al. Prevalence rates and predictors of generalized anxiety disorder symptoms in residents of Fort McMurray Six months after a wildfire. Fonrtiers in Psychiatry. 2018;9. doi: 10.3389/fpsyt.2018.

31. Dodd W, Scott P, Howard C, Scott C, Rose C, Cunsolo A, et al. Lived experience of a record wildfire season in the Northweat Territoies, Canada. Canadian J Public Health. 2018;109:327-339.

32. Adetona O, Reinhardt T, Domitrovich J, Broyles G, Adetona AM, Kleinman MT, et al. Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol. 2016;28((3):95-139. doi: 10.3109/08958378.2016.1145771. .

33. Barn PK, Elliott CT, Allen RW, Kosatsky T, Rideout K, Henderson SB. Portable air cleaners should be at the foreforng of the public health response to landscape fire smoke. Environmental Health. 2016;15:116. doi 10.1186/s12940-016-0198-9.

34. Wildfire Smoke. BCCDC. [Page on the internet]. Available at: Accessed: June 22, 219.

35. Leading Practices. BC Asthma Monitoring System (BCAMS). [Page on the Internet]. Available at: Accessed June 29, 2019. .

36. McLean KE, Yao J, Henderson SB. An Evaluation of the British Columbia Asthma Monitoring System (BCAMS) and PM2.5 exposure metrics during the 2014 forest fire season. Int J Environ Res Public Health. 2015;12:6710-6724; doi:10.3390/ijerph120606710.

37. Eilliott C, Henderson SB, Kosatsky T. Health impacts of wildfires: improving science and informing timely, effective emergency response. BCMJ. 2012;54(10):498.

38. Howcroft M, Walters EH, Wood-Baker R, Walters JAE. Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.:. CD005074. DOI:10.1002/14651858.CD005074.pub4.

39. Lenferink A, Brusse-Keizer M, van der Valk PDLPM, Frith PA, Zwerink M, Monninkhof EM, van der Palen J, Effing TW.Self-management interventions including action plans for exacerbations versus usual care in patientswith chronic obstructive pulmonary disease. . Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD011682. DOI: 10.1002/14651858.CD011682.pub2.

40. Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Medicine; 2017;15:64. Doi: 10.1186/s12916-017-0823-7.

41. Accessing Medicaitons You May Need During a State of Emergency. BC College of Pharmacists. [Page on the internet]. Available at: Accessed July 9, 2019.

42. Definitions You Should Know. [Page on the Internet]. Available at: Accessed: July 3, 2019. : s.n.

43. Sbihi H. Evidence Review: Using masks to protect public health during wildfire smoke events. March 31, 2014. [Document on the internet]. Available at: Accessed: June 22, 2019.

44. Wildfire Smoke: Frequently Asked Questions. [Document on the internet]. WorkSafeBC. July 2017. Available at: Accessed June 22, 2019.

45. Masks and N95 respirators. U.S. Food & Drug Administration. Current as of: 05/15/2018. [Page on the Internet]. Available at: Accessed July 3, 2019.

46. Respirator trusted - Source Information. Centers for Disease Control and Prevention. Page last reviewd: January 26, 2018. [Page on the internet]. Avaialble at: Accessed July 3, 2019.

47. Using Face Masks During Wildfire Smoke Events. [Page on the Internet]. Interior Heatlh. July 2016. Available at: Accessed June 22, 2019.

48. Vancouver Island. Wikipedia. [Page on the Internet'. Available at: Accessed Jun 22, 2019.

This article is featured in The Tablet. The Tablet features pharmacy and industry news, profiles on B.C. pharmacists, information on research developments and new products.